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Erschienen in: Intensive Care Medicine 1/2009

01.01.2009 | Original

Passive leg raising for predicting fluid responsiveness: importance of the postural change

verfasst von: Julien Jabot, Jean-Louis Teboul, Christian Richard, Xavier Monnet

Erschienen in: Intensive Care Medicine | Ausgabe 1/2009

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Abstract

Objective

For predicting fluid responsiveness by passive leg raising (PLR), the lower limbs can be elevated at 45° either from the 45° semi-recumbent position (PLRSEMIREC) or from the supine position (PLRSUPINE). PLRSUPINE could have a lower hemodynamic impact than PLRSEMIREC since it should not recruit the splanchnic venous reservoir.

Design

Prospective study

Setting

A 24-bed medical intensive care unit.

Patients and participants

A total of 35 patients with circulatory failure who responded to an initial PLRSEMIREC by an increase in cardiac index ≥ 10%.

Interventions

PLRSEMIREC, a transfer from the semi-recumbent to the supine position and PLRSUPINE were performed in all patients in a random order before fluid expansion (500 mL saline).

Measurements and results

PLRSEMIREC, supine transfer and PLRSUPINE significantly increased the pulse-contour derived cardiac index (PiCCOplus) by 22 (17–28)%, 9 (5–15)% and 10 (7–14)% (P < 0.05 vs. PLRSEMIREC for the latter two), respectively. These maneuvers significantly increased the right ventricular end-diastolic area (echocardiography) by 20 (14–29)%, 9 (5–16)% and 10 (5–16)% (P < 0.05 vs. PLRSEMIREC for the latter two) and the central venous pressure by 33 (22–50)%, 15 (10–20)% and 20 (15–29)% (P < 0.05 vs. PLRSEMIREC for the latter two), respectively. Volume expansion significantly increased cardiac index by 27 (21–38)% and all patients were responders to volume expansion. If an increase in cardiac index ≥ 10% is considered as a positive response to PLRSUPINE, 15 (43%) patients would have been unduly predicted as non-responders to fluid administration by PLRSUPINE.

Conclusions

PLRSEMIREC induces larger increase in cardiac preload than PLRSUPINE and may be preferred for predicting fluid responsiveness.
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Metadaten
Titel
Passive leg raising for predicting fluid responsiveness: importance of the postural change
verfasst von
Julien Jabot
Jean-Louis Teboul
Christian Richard
Xavier Monnet
Publikationsdatum
01.01.2009
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 1/2009
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1293-3

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